Thread by @CdnDrs4Medicare

Proponents of private pay health care often claim that countries with multi-payer health care systems (aka private pay + public pay) out-perform Canada 🇨🇦, but keep costs low and still cover everybody equitably. Sounds amazing. Is it true? Not quite. A #BetterMedicare 🧵/1

Like health care systems everywhere right now, Canada’s is struggling. No country is emerging from the pandemic unscathed - whether they have single- or multi- payer health care systems. /2

But we need to be cautious about drawing conclusions from health care systems in other countries. Each country must take into account the legacy of its history, its culture, its politics, and the values of its people. What works in one country may not work in another. /3

This video from @TheHubCanada talks specifically about three countries: the Netherlands 🇳🇱, Japan 🇯🇵, and the UK 🇬🇧, so let’s look at each. /4

In 🇳🇱, everyone must buy insurance from private insurers, with only 45% of funding coming from taxes. Another 45% comes from mandatory individual insurance premiums. A mandatory deductible further increases costs and financial risk to patients. commonwealthfund.org/international-… /5

Even with private insurance competing to drive down costs, 🇳🇱still spends ~10.5% of its GDP on health care, only 1% less than 🇨🇦 (~11.5%). Competing private insurers in the 🇳🇱 pushed up administrative costs. /6

In Japan 🇯🇵, total spending on health care consumes 11% of GDP, only slightly lower than 🇨🇦 (~11.5%) yet 84% of 🇯🇵’s health care is publicly-funded compared to just ~70% in 🇨🇦. /7

Extra public spending in 🇯🇵means that mental health, #pharmacare, #dentalcare, physical therapy, and certain home care services are also covered by the public purse. commonwealthfund.org/international-… /8

Private insurance in Japan plays only a supplementary role to pay for limited services, like orthodontics. /9

The UK 🇬🇧spends only ~ 9.8% of its GDP on health care, considerably less than 🇨🇦 (~11.5%). This relatively low public spending means costs have been shifted to individuals and private insurers. commonwealthfund.org/international-… /10

In the 🇬🇧, those who can afford to pay get rapid access to care & choice of specialists, which has increased inequity in access to care. The mismatch between funding, demand & the cost of providing services has also led to an underlying deficit of ~4.3 bn GBP (7.2bn CDN). /11

In the English NHS, outsourcing care to for-profit providers significantly increased rates of treatable mortality. It harmed patients.
thelancet.com/journals/lanpu…
pubmed.ncbi.nlm.nih.gov/12054406/ /12

What can we learn from other countries? 1) Multi-payer systems waste money paying private insurance administrators; single-payer plans like Canada’s are more efficient. 2) Countries that spend more money on health care can cover more services, so Canada should do the same. /13

Bottom line: Canada’s single-payer system keeps costs low and ensures equitable access to care. We need to strengthen our health care system & urgently improve access to care, but we can do that through better coordination in how we deliver care & increased public funding. /14

The solution is not to waste money on private insurance that duplicates what’s already covered in our public plans, nor is it forcing patients to pay out-of-pocket. #BetterMedicare /end